Bridging Meds

Bridging meds is a process in correctional healthcare of covering the medication gap between what the inmate was taking in the community and what is provided behind bars. Recent reports of inmate death or violence related to not providing prescribed medications in a timely fashion can easily lead to the question – “How hard can it be to get them the right medications?” Indeed, it can be more challenging than it first appears.

The guiding principle is for the facility medical unit to validate any prescribed medications and provide to the inmate necessary medications from stock until an individual prescription can be started for the duration of their stay.

Inmates come in with unknown medications

Many arrestees come in to the jail from the street with their own personal medications. However, they have often been removed from the original containers with the prescription label. The best situation is when the medications are in the original bottles and can easily be validated by the facility healthcare providers. Unfortunately, more often than not, the person arrives with a mixture of unidentifiable pills in a personal container or pocket. Since many inmates are detained for drug charges, it is unacceptable to allow the inmate to self-medicate using unknown and unvalidated medications.

Knowledge of medications and providers

Many people are unable to articulate the medications they take and the primary reason for the medication. This is intensified in the corrections setting. Misinformation abounds and must be sorted out to deliver care behind bars. If the individual is not carrying the medication with them and can not identify their prescribing physician, medication can not be provided until a full evaluation and treatment plan is determined by a prescribing provider (NP, PA, MD).

Connecting with the community provider

The greatest number of arrests do not take place during normal business hours. Delays in medication delivery can take place during weekends and off hours while awaiting communication with the primary provider.

Medication not on formulary or in stock

Occasionally a medication is needed that is not on formulary or not in stock at the facility. This can also lead to a delay while the medication is located. Well-managed correctional healthcare units will have a local back-up pharmacy which can handle emergency need for unusual medications until scripts can be filled through the standard pharmacy channels.

Inmate can’t be found

Seems odd that an inmate can’t be found when behind bars, but it happens. The transient nature of the jail situation, in particular, can lead to missed medication. The inmate may have been released, had a court date, or been transferred. If communication between custody and the healthcare unit is spotty, these gaps in medication delivery can happen.

Summary

For all these reasons, every correctional facility needs a solid system for bridging medications including tracking, good community and intrafacility connections, and extreme diligence to follow-through on medication delivery. Each healthcare staff member must understand the importance of their actions in the information and treatment chain. If there is a breakdown in any of these areas, disaster can strike.

Guest post by Dr. Lorry Schoenly nurse author and educator specializing in the field of correctional health care. She has written 4 continuing education courses especially for the Correctional Healthcare Campus.